ch 49 prep U

Which client would the nurse identify as being opioid naive?

one who does not routinely take opioids

The nurse is caring for four clients. For which client would the nurse question the health care provider's order of IV morphine?

A 78-year-old with osteoarthritis. Older clients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal, and cardiovascular effects.

A client's family asks why the nurse has placed suction equipment in the room immediately after administering a dose of naloxone (Narcan). Which explanation by the nurse is correct?

Abrupt reversal of opioid-induced respiratory depression may cause vomiting. It is important to keep suction equipment readily available because abrupt reversal of opioid-induced respiratory depression may cause vomiting.

To decrease the risk of injury to a client taking an opioid, what should the nurse do? (Select all that apply.)

Assist client from their bed to the toilet. Assist client with rising from a lying position. Assist client with hall-walking activities.

The nurse has administered a dose of naloxone (Narcan) and the client's respiratory depression improved within five minutes. When the nurse reassessed the client two hours later, the client demonstrates symptoms of respiratory depression. Which action should the nurse perform next?

Call the provider as another dose of opioid antagonist may be necessary. The effects of some opioids may last longer than the effects of naloxone (Narcan). A repeat dose of naloxone may be ordered if results obtained from the initial dose are unsatisfactory. Therefore, calling for an order would be an appropriate response. Taking no action in light of respiratory depression, or merely continuing to monitor the client, could lead to deterioration in the client's condition. No medication should be administered without a provider order.

A client who is receiving an opioid develops a slowed breathing pattern due to the drug's effect of somnolence and pain relief. When providing care to this client, which would be most important for the nurse to do?

Coach the client to breathe. Sometimes the somnolence and pain relief produced by the opioid drug will slow the client's breathing pattern. The nurse should make efforts to arouse the client and coach him or her to breathe.

A patient is receiving drugs through a PCA infusion pump. Which of the following information should a nurse offer to the patient for proper administration of the drug through the infusion pump?

Control button activates administration of the drug. The nurse should inform the patient that the control button activates administration of the drug. Pain relief occurs shortly after, and not an hour after, pushing the button. The nurse should educate the patient on the difference between the control button and the button to call the nurse, especially when they are similar in appearance and feel. The machine does not deliver the drug every time the control button is used; the machine regulates the dose of the drug as well as the time interval between doses. If the control button is used too soon after the last dose, the machine will not deliver the drug until the correct time.

The nurse is administering morphine to a trauma client for acute pain. What is a common side effect of morphine?

Drowsiness. Dizziness, drowsiness, and visual changes are common side effects. If any of these occur, avoid driving, operating complex machinery, or performing delicate tasks. If these effects occur in the hospital, the side rails on the bed may be raised for your own protection.

The nurse is caring for a client who has been admitted to the emergency department after a fall. An x-ray indicates that the client has fractured his ankle. Because of a previous stroke, the client does not speak. What other method will the nurse use to assess this client's pain? (Select all that apply.)

Facial expressions Movement of arms and hands Guarding of the leg

Naloxone (Narcan) will reverse the effects of which drug?

Fentanyl (Duragesic). Naloxone (Narcan) is an opioid antagonist, which means it will only reverse the effects of opioids like fentanyl (Duragesic).

A client is to receive a narcotic that will be applied transdermally. The nurse identifies this as which agent?

Fentanyl.

A nurse is assessing a client's pain level. Which would be the most appropriate method?

Have the client rate it on a scale of 1 to 10. The most appropriate method for assessing pain is to have the client rate his pain by using some type of scale. This provides objective evidence of the severity of the pain and provides a basis for comparison later on.

The nurse is explaining to a client about the analgesic and its possible adverse effects. The client is receiving an opioid analgesic. What would be important to teach this client is a possible adverse effect of this drug?

Hypotension. Orthostatic hypotension is commonly seen with some narcotics

Naloxone (Narcan) is administered via which of the following? Select all that apply:

IV push IV piggyback Naloxone (Narcan) is administered by IV infusion requiring the use of a secondary line, an IV piggyback, or an IV push.

Although naloxone (Narcan) is given to counter opioid medication side effects such as respiratory depression, what additional issues (if any) may result from administration of an opioid antagonist?

Increase in the client's pain rating. An opioid antagonist will counter not only the negative effects of an opioid medication but the beneficial effects of the opioid (such as pain relief) as well, resulting in an increase in the client's pain rating.

When teaching a client about patient-controlled analgesia (PCA), which would the nurse integrate into the teaching plan?

Many postoperative clients require less opioid when PCA is used.

The nurse assesses that the client is having pain. The nurse askes the client to rate his pain on the pain scale. The client is unable to rate the pain, stating that it just hurts so bad he can't think. What is the most appropriate response of the nurse?

Medicate the client for pain. If the nurse identifies the client is having pain, but the client cannot effectively rate the pain, the nurse should medicate the client. Pain medication should never be withheld. Continuing to try to get the client to use a pain scale; using the family can be highly frustrating and can cause a delay in getting the client the relief he needs. Once medicated, the nurse can find an alternate pain scale if the client cannot use the normal pain scale.

A client is undergoing inpatient addiction rehabilitation following many years or addiction to heroin. What medication would be the most useful adjunct to treatment?

Methadone. Methadone is used for detoxification and temporary maintenance treatment of narcotic addiction. Oxycodone is used for the relief of moderate to severe pain in adults. Oxymorphone is used for the relief of moderate to severe pain in adults, preoperative medication, and obstetrical analgesia. Tramadol is used for the relief of moderate to moderately severe pain, and its use should be limited in clients with a history of addiction.

The pediatric nurse is providing care for several clients on the unit who are experiencing pain. The nurse should anticipate that clients may be ordered which narcotic analgesics? Select all that apply.

Morphine Meperidine Hydrocodone Narcotics that have an established pediatric dose include codeine, fentanyl (but not the transdermal form), hydrocodone, meperidine, and morphine. Methadone is not recommended as an analgesic in children.

A patient is prescribed naloxone for the treatment of postoperative acute respiratory depression after a kidney transplant operation. Which of the following should the nurse identify as the action of naloxone?

Naloxone restores respiratory function.

The client returns from the post-anesthesia recovery unit. The nurse notes a respiratory rate of 6. Which drug would the nurse anticipate being given immediately?

Narcan. Narcan has long been the drug of choice to treat respiratory depression caused by an opioid. Therapeutic effects occur within minutes after IV, IM, or sub-q injection and last 1 to 2 hours.

A client who was recently diagnosed with cancer is now receiving morphine for pain. Since this client has been receiving morphine for only a short time, he is best described by which term?

Opiate naive. An opiate tolerant client is one who, because of previous opioid use, has developed a drug tolerance. An opioid tolerant client typically requires a larger-than-usual dose for pain relief. Conversely, an opiate naive client has not received sufficient opioids for development of tolerance. The client described in the scenario is opiate naive.

Which of the following terms would the nurse expect health care professionals to use to describe drugs used in pain management?

Opioids.

A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments?

Pain intensity, respiratory rate, and level of consciousness

Keith, 12 years old, is seen in the emergency department for a severe sunburn. He reports pain, which he rates 7/10. What type of pain is he suffering from?

Superficial somatic pain. Sunburn is an example of superficial somatic pain. Somatic pain is characterized as well localized and intermittent, or as constant, aching, gnawing, throbbing, burning, or cramping. Neuropathic pain can be described as shooting, burning, or stabbing and generally follows a radicular or radiating pattern. The bone and joint pain of arthritis and muscle strains after intense physical exertion are examples of deep somatic pain. Visceral pain results from stimulation within the deep tissues or organs and surrounding structural tissues.

It is important for the nurse to recognize the symptoms of the abstinence syndrome in clients taking opioids. Which of the following are intermediate symptoms of the abstinence syndrome? Select all that apply:

Tachycardia Mydriasis Intermediate symptoms of the abstinence syndrome include mydriasis, tachycardia, twitching, tremor, restlessness, irritability, anxiety, and anorexia.

Of the following clients, which one will be most likely to develop physical dependence upon the opioid analgesic they are receiving for pain management?

The client living with a chronic noncancer-related illness. The client living with a chronic, noncancer-related illness will be the one receiving the highest dose in the most frequent time interval; this client is considered chronically ill. The clients recovering from surgical procedures (cholecystectomy and below-knee amputation) as well as an ankle fracture are receiving opioid analgesics for acute pain, and will be healed before physical dependence develops.

The nurse is caring for a postoperative client with a history of opioid abuse who has been ordered to receive a dose of an opioid antagonist medication. Which issues should the nurse be prepared to address?

The client may begin to demonstrate symptoms of withdrawal.

When evaluating the plan of care for a client receiving opioid analgesics for pain management, the nurse considers the plan successful when what occurs? (Select all that apply.)

Therapeutic response is achieved and discomfort is reduced. An adequate breathing pattern is maintained. Client maintains adequate nutritional status.

When teaching a client about the action of an opioid antagonist, what should the nurse include in the education?

This medication competes with the opioid pain medication, binding to the cell receptors instead.

A group of students is reviewing various methods for assessing pain. The students demonstrate understanding of the material when they identify what as the most reliable method?

Using a pain rating scale

The nurse has just administered an opioid antagonist to a client who had been experiencing respiratory depression. How soon can the nurse expect to see improvement in the client's respiratory function?

Within one to five minutes, an effect may be seen.

A postsurgical client has been prescribed morphine to address the pain that is anticipated over the next 24 to 48 hours. What is the most effective strategy to manage a client's postsurgical pain for the initial 24 to 48 hours?

administering morphine on a scheduled basis and supplementing it with additional morphine when the pain worsens.

A client is to receive a narcotic cough syrup. The nurse would expect this preparation to contain:

codeine. Typically, codeine or hydrocodone are used to relieve coughing.

After obtaining the history of a client who is prescribed opioid therapy, the nurse determines that the client is opioid naive. The nurse would be especially alert for which effect after the client receives the prescribed opioid?

respiratory depression.

An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the client that:

there is risk of an extremely high dose available all at once if the tablet is crushed.